Abstract:Objective The objective of our study was to conduct meta-analyses that examined the association between H7N9-infected case-fatality risk(CFR)and underlying medical conditions(UMCs)by adjusting some potential factors variables. Methods The articles of observational studies and randomized controlled clinical trials(RCT)on the association between UMCs and the CFR of H7N9-infected patients were collected and selected according to inclusion and exclusion criteria. Meta-analysis was performed to calculate odds ratio(OR)or adjusted OR(AOR)and 95% confidence interval(CI)to assess the association between H7N9-infected CFR and UMCs. Results Among 1 934 screened articles,we identified 14 articles reporting the CFR of H7N9-infected patients based on UMCs data. The pooled summary estimates from these studies indicated that UMCs significantly increased the risk of death in H7N9 patients (OR=2.20,95%CI:1.76-2.76). Subgroup analyses showed chronic respiratory diseases (CRD,OR=4.43,95%CI:1.73-11.31),immuno-suppressive disorders(ISD,OR=4.65,95% CI:1.48-44.70),and two UMCs and above(OR=2.13,95% CI:1.26-5.97) were significantly associated with H7N9-infected CFR; while 60 years old and above (AOR=4.83,95%CI:1.29-18.09),male(AOR=2.35,95%CI:1.03-5.39),time intervals to oseltamivir treatment(over 5 days)(AOR=5.74,95%CI:1.15-28.66)and hospitalization(over 8 days)(AOR=2.72,95%CI:1.20-6.15),and initially bilateral lungs infection(AOR=7.95,95%CI:1.56-40.41)of UMCs patients who died from H7N9 infection are much greater compared with non-UMCs. Stratification analyses confirmed statistically significant increasing effects of CFR were observed in 60 years old and above(AOR=2.20,95%CI:1.12-4.30),time intervals to oseltamivir treatment(over 5 days)(AOR=3.19,95%CI:1.56-6.53),and initially bilateral lungs infection(AOR=3.48, 95%CI:1.74-6.95)compared with 0-59 years old,time intervals to oseltamivir treatment(5 days and below),and initially single lung infection respectively in H7N9-infected patients with UMCs. Conclusions We find that only CRD,ISD,and two UMCs and above are associated with increased risk of death in H7N9-infected patients. We also suggest that a high CFR is associated with 60 years old and above,delayed antiviral treatment,and initially bilateral lungs infection in H7N9-infected patients with UMCs.
杨洛贤, 程庆林, 张琼, 谢立. 慢性基础疾病与人感染H7N9禽流感病死风险校正关联性的Meta分析[J]. 预防医学, 2018, 30(6): 557-564,569.
YANG Luo-xian, CHENG Qing-lin, ZHANG Qiong, XIE Li. Association between underlying medical conditions and fatality risk in H7N9-infected patients: a meta-analysis. Preventive Medicine, 2018, 30(6): 557-564,569.
[1] ZHANG Y,LIU J,YU L,et al. Prevalence and characteristics of hypoxic hepatitis in the largest single-centre cohort of avian influenza A(H7N9)virus-infected patients with severe liver impairment in the intensive care unit[J] . Emerg Microbes Infect,2016,5:el. [2] FENG F,JIANG Y,YUAN M,et al. Association of radiologic findings with mortality in patients with avian influenza H7N9 pneumonia[J] . PLoS ONE,2014,9(4):e93885. [3] WANG C,YU H,HORBY P W,et al. Comparison of patients hospitalized with influenza A subtypes H7N9,H5N1,and 2009 pandemic H1N1[J] . Clin Infect Dis,2014,58(8):1095- 1103. [4] LU S,ZHENG Y,LI T,et al. Clinical Findings for Early Human Cases of Influenza A(H7N9) Virus Infection,Shanghai,China[J] . Emerging Infectious Diseases,2013,19(7):1142-1146. [5] Oxford centre for evidence-based medicine. Critical Appraisal Skills Programme(CASP)[EB/OL] .(2017-06-04)(2017-10-12] . http://www.casp-uk.net/. [6] JI H,GU Q,CHEN L L,et al. Epidemiological and clinical characteristics and risk factors for death of patients with avian influenza A H7N9 virus infection from Jiangsu Province,Eastern China[J] . PLoS ONE,2014,9(3):e89581. [7] VIRLOGEUX V,YANG J,FANG V J,et al. Association between the severity of influenza A(H7N9)virus infections and length of the incubation period[J] . PLoS ONE,2016,11(2):e0148506. [8] LIU S,SUN J,CAI J,et al. Epidemiological,clinical and viral characteristics of fatal cases of human avian influenza A (H7N9) virus in Zhejiang Province,China[J] . J Infect,2013,67(6):595-605. [9] LIU X,ZHANG Y,XU X,et al. Evaluation of plasma exchange and continuous veno-venous hemofiltration for the treatment of severe avian influenza A (H7N9):a cohort study[J] . Ther Apher Dial,2015,19(2):178-184. [10] ZHANG A,HUANG Y,TIAN D,et al. Kinetics of serological responses in influenza A(H7N9)-infected patients correlate with clinical outcome in China,2013[J] . European communicable disease bulletin,2013,18(50):20657. [11] CHENG Q L,DING H,SUN Z,et al. Retrospective study of risk factors for mortality in human avian influenza A(H7N9)cases in Zhejiang Province,China,March 2013 to June 2014[J] . Int J Infect Dis,2015,39:95-101. [12] 谢立,程庆林,丁华,等. 杭州市人感染 H7N9禽流行性感冒死亡危险因素分析[J] . 中华传染病杂志,2014,32(11):683- 687. [13] 柴程良,陈恩富,陈直平,等. 浙江省6例人感染H7N9禽流感确诊病例的临床与流行病学特征分析[J] . 中华流行病学杂志,2013,34(5):443-445. [14] WU Z Q,ZHANG Y,ZHAO N,et al. Comparative epidemiology of human fatal infections with novel,high(H5N6 and H5N1)and low(H7N9 and H9N2)pathogenicity avian influenza a viruses[J] . International Journal of Environmental Research and Public Health,2017,14(12):263. [15] WANG H,XIAO X,LU J,et al. Factors associated with clinical outcome in 25 patients with avian influenza A(H7N9)infection in Guangzhou,China[J] . BMC Infect Dis,2016,16(1):534. [16] CHEN Y,LI X,TIAN L,et al. Dynamic behavior of lymphocyte subgroups correlates with clinical outcomes in human H7N9 infection[J] . J Infect,2014,69(4):358-365. [17] PEBODY R G,MCLEAN E,ZHAO H,et al. Pandemic Influenza A(H1N1)2009 and mortality in the United Kingdom:risk factors for death,April 2009 to March 2010[J] . Euro surveillance,2010,15(20):pii/19564- pii/19564. [18] RIBEIRO A F,PELLINI A C,KITAGAWA B Y,et al. Risk factors for death from Influenza A(H1N1)pdm09,State of S?o Paulo,Brazil,2009[J] . PLoS ONE,2015,10(3):e0118772. [19] HENNESSY T W,BRUDEN D,CASTRODALE L,et al. A case-control study of risk factors for death from 2009 pandemic influenza A(H1N1):is American Indian racial status an independent risk factor?[J] . Epidemiology and Infection,2015(2):315-324. [20] GAO H N,LU H Z,CAO B,et al. Clinical findings in 111 cases of influenza A(H7N9)virus infection[J] . N Engl J Med,2013,368(24):2277-2285. [21] GUAN Y,FAROOQUI A,ZHU H,et al. H7N9 Incident,immune status,the elderly and a warning of an influenza pandemic[J] . J Infect Dev Ctries,2013,7(4):302-307. [22] BERMEJO-MARTIN J F,ALMANSA R,ORTIZ DE LEJARAZU R. Weakened immunity in aged hosts with comorbidities as a risk factor for the emergence of influenza A H7N9 mutants[J] . J Infect Dev Ctries,2013,7(6):497-498. [23] ZHOU Y,WANG C,YAO W,et al. COPD in Chinese nonsmokers[J] . Eur Respir J,2009,33(3):509-518. [24] KAISER L,WAT C,MILLS T,et al. Impact of oseltamivir treatment on influenza-related lower respiratory tract complications and hospitalizations[J] . Arch Intern Med,2003,163(14):1667-1672. [25] DAI J,ZHOU X,DONG D,et al. Human infection with a novel avian-origin influenza A (H7N9) virus:serial chest radiographic and CT findings[J] . Chin Med J,2014,127(12):2206-2211. [26] KO S F,LEE T Y,HUANG C C,et al. Severe acute respiratory syndrome:prognostic implications of chest radiographic findings in 52 patients[J] . Radiology,2004,233(1):173-181. [27] SIMONSEN L,TAYLOR R J,YOUNG-XU Y,et al. Impact of pneumococcal conjugate vaccination of infants on pneumonia and influenza hospitalization and mortality in all age groups in the United States[J] . mBio,2011,2(1):e00309-e00310. [28] 陈炜,陈金强,鲁君敏,等. 3例人感染H7N9禽流感重症病例临床特征分析[J] . 预防医学,2016,28(10):1031-1033. [29] GOKA E A,VALLELY P J,MUTTON K J,et al. Mutations associated with severity of the pandemic influenza A(H1N1)pdm09 in humans:a systematic review and meta-analysis of epidemiological evidence[J] . Arch Virol,2014,159(12):3167-3183. [30] WANG C B,CHIU M L,LIN P C,et al. Prompt oseltamivir therapy reduces medical care and mortality for patients with influenza infection:An Asian population cohort study[J] . Medicine (Baltimore),2015,94(27):e1070. [31] ADISASMITO W,CHAN P K,LEE N,et al. Effectiveness of antiviral treatment in human influenza A(H5N1) infections:analysis of a Global Patient Registry[J] . J Infect Dis,2010,202(8):1154-1160. [32] YANG S,CAO B,LIANG L,et al. Antiviral therapy and outcomes of patients with pneumonia caused by influenza A pandemic (H1N1) virus [J] . Plos one,2012,7(1):e29652.